| NPI | 1205438546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL MA76197) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA30066) |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2020-11-11 |